Our Experience with the Haemophiliac in Need for Surgery

S. Andronescu-Ghika, MD, Centrul de Hematologie, Bucuresti (Romania) The necessity for surgical interventions has for many years been considered as a serious risk for the haemophiliac. Small surgery, however (such as sutures of superficial wounds, incision of abscesses, etc.) could be done rather easily but the surgery of internal organs was performed only when an emergency forced the issue. Such difficulties have been prevalent in our country until not so long ago. Laparotomy for emergency abdominal conditions was considered by the surgeon with a great deal of skepticism, even when large quantities of anti-haemophilic plasma and/ or frozen plasma were available. The increasing number of emergencies in haemophiliacs determined the search for a solution, and this is reflected in the present study. The problems related to the laboratory diagnosis were solved by the production of special reagents, as well as by the introduction of new devices, and organizational aspects have been dealt with by preparing complete files for a total of 607 patients with type A, and for 73 with type B haemophilia. The most important problem was that of cryoconcentrate production. This was started at a modest rate in 1972, when only 80 flaks were prepared, but the production attained nearly 2,000 flaks in 1979. Production of cryoconcentrate was also started in some other blood collection and transfusion centres in the country. The introduction of the cryoconcentrate made possible the application of surgical procedures for haemophiliacs, and this is done in a unified manner in the whole country, where the same schemes for the therapy have been recommended in all the clinics where haemophiliacs are hospitalized. During 1979 we have been requested to provide assistance in 138 medical and 22 surgical problems regarding haemophiliacs. The medical cases included haemar-throses with various localizations (predominantly of the knees), as well as haematuria, epistaxis, spontaneous haematomas, menin-geal haemorrhages and cerebral compression, and cerebral haematoma. The surgical cases consisted of fractures, posttraumatic wounds, appendicitis, hernia, peritonitis, stomatological and orthopaedic interventions. We have started by carefully assessing the patients, using multiple tests also aimed Our Experience with the Haemophiliac in Need for Surgery 199